Surgery for advanced epithelial ovarian cancer by transumbilical laparoendoscopic single-site surgery combined with upper abdominal laparotomy

doi:10.3877/cma.j.issn.1674-6899.2024.03.010

Abstract

Abstract:

Objective

This study aims to investigate the feasibility and safety of debulking surgery(DS) via transumbilical laparoendoscopic single-site(TU-LESS)approach combined with upper abdominal laparotomy in advanced ovarian cancer.

Methods

Retrospective analysis of the perioperative outcomes of patients with advanced ovarian cancer who underwent TU-LESS combined with upper abdominal laparotomy from Mar. 2022 to Aug. 2023 in a single institution.

Results

Six patients underwent TU-LESS combined with upper abdominal laparotomy for DS successfully, and all of them achieved complete cytoreduction(R0). The average operative time was 417.50±103.09 mins, and the intraoperative bleeding was 566.67±273.25 ml, and the average postoperative hospital stay was 6.5±0.837 days. Only one patient developed postoperative lymphocyst. Six patients underwent follow-up chemotherapy as scheduled after DS.

Conclusion

TU-LESS approach combined with upper abdominal open surgery ensures tumor cell reduction and exhibits the characteristics of minimally invasive procedures, as well as, which impacts patient prognosis positively. This combined surgical approach is safe and feasible.

Key words: Transumbilical single-port laparoscopy, Ovarian cancer, Combined with upper abdominal laparotomy

Lu Jiang, Ying Zheng, Fan Yang, Qiao Wang, Na Wang, Chuanhua Yang, Yu Chen, Jiani Gou, Lusi Deng, Xu Yang. Surgery for advanced epithelial ovarian cancer by transumbilical laparoendoscopic single-site surgery combined with upper abdominal laparotomy[J]. Chinese Journal of Laparoscopic Surgery(Electronic Edition), 2024, 17(03): 177-181.

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病例	1	2	3	4	5	6
年龄(岁)	50	43	48	53	51	63
BMI( kg/m²)	28.0	24.6	19.9	25.3	21.8	22.1
初次治疗时的CA125(u/ml)	97.1	401.6	1488.5	7329	494.4	2497
IDS术前CA125(u/ml)	－	7.7	23.8	87.7	12.5	25.6
初次治疗时Suidan评分(分)	2	11	9	8	6	5
NACT后Suidan评分(分)	－	2	1	2	2	1
初次治疗时Fagotti评分(分)	4	－	8	8	10	8
NAC后Fagotti评分(分)	－	4	2	4	4	2
诊断	卵巢高级别浆液性腺癌	卵巢高级别浆液性腺癌	卵巢低级别浆液性腺癌	卵巢高级别浆液性腺癌	卵巢高级别浆液性腺癌	卵巢高级别浆液性腺癌
分期	FIGO，ⅢC期	FIGO，ⅢC期	FIGO，ⅢC期	FIGO，ⅣB期	FIGO，ⅣA期	FIGO，ⅣA期

病例	1	2	3	4	5	6
年龄(岁)	50	43	48	53	51	63
BMI( kg/m²)	28.0	24.6	19.9	25.3	21.8	22.1
初次治疗时的CA125(u/ml)	97.1	401.6	1488.5	7329	494.4	2497
IDS术前CA125(u/ml)	－	7.7	23.8	87.7	12.5	25.6
初次治疗时Suidan评分(分)	2	11	9	8	6	5
NACT后Suidan评分(分)	－	2	1	2	2	1
初次治疗时Fagotti评分(分)	4	－	8	8	10	8
NAC后Fagotti评分(分)	－	4	2	4	4	2
诊断	卵巢高级别浆液性腺癌	卵巢高级别浆液性腺癌	卵巢低级别浆液性腺癌	卵巢高级别浆液性腺癌	卵巢高级别浆液性腺癌	卵巢高级别浆液性腺癌
分期	FIGO，ⅢC期	FIGO，ⅢC期	FIGO，ⅢC期	FIGO，ⅣB期	FIGO，ⅣA期	FIGO，ⅣA期

病例	1	2	3	4	5	6
手术时间(min)	315	560	465	496	350	320
术中出血(ml)	300	500	900	300	900	500
术后住院天数(d)	6	6	6	8	7	6
术中/术后并发症	无	无	淋巴囊肿	无	无	无
开腹手术探查较腹腔镜探查增加的病灶情况	回肠肠襻、肝肾间隙、肝胃间隙、脾肾间隙、小肠系膜根部等处见大小约0.5～1.5 cm的病转移病灶	肝肾隐窝见2 cm转移病灶，小肠、回肠肠襻之间、脾胃曲、肝胃曲分别见大小约0.5～1 cm的转移病灶	－	－	结肠脾曲的病灶，大小约2 cm	－
特殊手术情况	－	肠管表面病灶切除术后行肠修补术	－	部分膈肌切除术、心膈角转移淋巴结切除术	肠管表面病灶切除术后行肠修补术	－

病例	1	2	3	4	5	6
手术时间(min)	315	560	465	496	350	320
术中出血(ml)	300	500	900	300	900	500
术后住院天数(d)	6	6	6	8	7	6
术中/术后并发症	无	无	淋巴囊肿	无	无	无
开腹手术探查较腹腔镜探查增加的病灶情况	回肠肠襻、肝肾间隙、肝胃间隙、脾肾间隙、小肠系膜根部等处见大小约0.5～1.5 cm的病转移病灶	肝肾隐窝见2 cm转移病灶，小肠、回肠肠襻之间、脾胃曲、肝胃曲分别见大小约0.5～1 cm的转移病灶	－	－	结肠脾曲的病灶，大小约2 cm	－
特殊手术情况	－	肠管表面病灶切除术后行肠修补术	－	部分膈肌切除术、心膈角转移淋巴结切除术	肠管表面病灶切除术后行肠修补术	－

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